To identify the risk factors associated with pathogenic organisms in surgical site wound infections after cardiac surgeries in specialized cardiac hospital
Date of Award
Master of Science in Nursing (MScN)
School of Nursing and Midwifery, Pakistan
Hospital admission, especially for a major surgery, exposes patients to different types of pathogenic microbial flora. Patients are usually at a high risk and can be infected by these pathogens and suffer from surgical site wound infections (Tacconelli et al., 2009). It has also been reported that post-operative wound infections after major cardiac surgeries are an important cause of morbidity and, sometimes, mortality as well. There are many factors that lead to HCA Is, which can be classified into modifiable and non-modifiable factors. Some variables such as age and gender are obviously not modifiable and cannot be changed (Yusuf et al., 2010). However, there are some risk factors that are modifiable, like, obesity, smoking, diabetes mellitus, and hypertension. Objectives: This study aimed at identifying the risk factors of wound infection after Cardiac surgery and the pathogenic organisms of the presenting wound. These organisms have different sensitivity and resistance patterns, according to their classification and nature. Indeed, the treatment of wound infection depends on their nature and classification. Due to this reason. this research aimed to explore whether there was a relation between the identified pathogenic micro-organisms and the patients' risk factors or not, at a tertiary care cardiac hospital. Methodology: The "quantitative descriptive design" was used for this research. This study utilized the retrospective data related to patients who underwent cardiac surgery and developed surgical site wound infections between January 2015 and December 2015, at a tertiary care cardiac hospital in Karachi, Pakistan. The data used was collected through self—developed data abstraction tool. The SPSS version 19.0 and Microsoft Excel were used for data entry, and then the collected data was refined and analyzed using descriptive and inferential (Chi square) statistics. Results: The analysis of the data shows that a total of 64 patients got surgical site infections after cardiac surgery. Out of them, 45 were male and 19 were female. The majority (45.3%) of participants were 5 I to 60 years of age. Most of the patients, like. 76.6% were hypertensive and 70.3% were Diabetic. 45.3% patients were using tobacco, according to the patients' charts. Most of the patients (67.2%) were obese. According to Microbiological investigation, Staphylococcus Aureus was the most common pathogen, i.e. 50% among all Staphylococcus, MRSA was found to be the common pathogens (38%) followed by the gram negative pathogen i.e. Pseudomonas Aeruginosa and Klebsiella species. Very few percentages are also found in other gram positive and negative bacteria. According to association there is a high significance of DM and Staph infections (p=<0.005). Moreover, no association was found between the gram negatives and risk factors, except Pseudomonas. Pseudomonas commonly found in male gender only. According to the susceptibility pattern of pathogens, 38% were MRSA; and Acinetobacter were found to be sensitive to Carbapenum group of antibiotics. All gram positive bacteria were 100 % sensitive to Vancomycin and linezolid. No VRE and VRSA were found in this study population. Conclusion: The findings highlight the relationship of pathogens with patients' existing risk factors. According to this study one can conclude that there is an association between gram positive pathogens and the risk factors of patients. However, for gram negative infections, infection control policies must be followed top revent cross transmission. Moreover, a clean environment must be maintained as far as possible. Antibiotic guidelines could be revised and clinicians could add gram negative coverage as prophylactic antibiotics before surgery.
Liaquat, S. (2017). To identify the risk factors associated with pathogenic organisms in surgical site wound infections after cardiac surgeries in specialized cardiac hospital (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.